目的 对于尿毒症继发甲状旁腺功能亢进患者接受手术治疗的麻醉管理进行探讨。方法 选取2018年1月—2020年1月接诊的尿毒症继发甲状旁腺功能亢进患者20例为观察对象,所选20例尿毒症继发甲状旁腺功能亢进患者全部接受全麻下甲状旁腺切除手术治疗,通过回顾性分析方法分析患者的麻醉管理情况。结果 20例尿毒症继发甲状旁腺功能亢进患者在全麻状态下完成手术治疗,其中14例患者手术期间产生低血压,10例患者手术期间接受去甲肾上腺素持续泵注,患者手术之后的血钙以及血磷水平和手术之前1 d对比不存在明显差异,手术之后1 d的钙离子浓度显著低于手术之前1 d。手术之后8例患者产生低钙表现,其中5例低钙血症患者在手术之后第1天产生口唇麻木以及手指麻木感,通过及时的补钙治疗麻木症状消失。2例患者手术期间产生高钾血症,通过极化液之后血钾水平恢复到正常。20例尿毒症继发甲状旁腺功能亢进患者的苏醒时间平均为（8.50±1.16）min,拔管时间平均为（9.24±1.59） min。20例患者麻醉效果：Ⅰ级10例,Ⅱ级8例,Ⅲ级2例,麻醉有效率为90.0%。结论 尿毒症继发甲状旁腺功能亢进患者接受全麻诱导之后和手术期间十分容易产生低血压表现,手术期间需要严格监测患者的血压水平,合理选择升压药物,并且提高电解质的监测力度,从而提高手术麻醉安全性。

Objective To discuss the anesthesia management in surgical treatment of uremia secondary hyperparathyroidism. Methods Twenty patients with uremia secondary hyperparathyroidism who were admitted from January 2018 to January 2020 were selected as study subjects, and treated by parathyroidectomy under general anesthesia. Their anesthesia management was analyzed retrospectively. Results During the surgery, 14 out of the 20 patients had low blood pressure, and 10 patients received continuous pumping of norepinephrine. The blood calcium and blood phosphorus levels after surgery were not significantly different from those 1 day before surgery. The calcium ion concentration 1 day after surgery was significantly lower than that 1 day before surgery. Among the 8 patients who developed hypocalcemia after surgery, 5 patients developed numbness in the lips and fingers 1 day after surgery, and then received timely calcium supplementation to address the symptoms. Hyperkalemia occurred in 2 patients during operation, and their serum potassium level were reduced to a normal range after glucose-insulin-potassium solution. The average waking time and extubation time of the 20 patients with uremia secondary hyperparathyroidism were （8.50±1.16） min and （9.24±1.59） min respectively. The distributions of the anesthesia effects among the 20 patients were level I for 10 cases, level Ⅱ for 8 cases, and level Ⅲ for 2 cases; the effective rate of anesthesia was 90.0%. Conclusion Patients with hyperparathyroidism secondary to uremia are very likely to have hypotension after induction of general anesthesia and during the operation. The patients’ blood pressure and electrolyte should be strictly monitored during the operation, and hypertensors should be applied as appropriate, thus ensuring the safety of surgical anesthesia.